Provider Demographics
NPI:1508146549
Name:LIRA, CANDACE LYNETTE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:LYNETTE
Last Name:LIRA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 E 16TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67152-2828
Mailing Address - Country:US
Mailing Address - Phone:620-326-3301
Mailing Address - Fax:620-326-3301
Practice Address - Street 1:507 E 16TH ST STE 1
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:KS
Practice Address - Zip Code:67152-2828
Practice Address - Country:US
Practice Address - Phone:620-326-3301
Practice Address - Fax:620-326-3301
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01470363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS12277183OtherCAQH
KS111241001OtherMEDICARE
KS1508146549OtherBCBS
KS200738580Medicaid